Bringing Assisted Living Services into Congregate Housing |
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| Authors: | Kathryn Hyer MPP PhD Kali S Thomas MA PhD Christopher E Johnson PhD Jeffrey S Harman PhD Robert Weech-Maldonado MBA PhD |
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| Institution: | 1. Associate Professor and Director, Florida Policy Exchange Center on Aging, School of Aging Studies , University of South Florida , Tampa , Florida , USA khyer@usf.edu;3. Postdoctoral Fellow, Center for Gerontology and Healthcare Research , Brown University , Providence , Rhode Island , USA;4. Associate Professor and Department Head, Department of Health Policy and Management , Texas A&5. M Health Science Center , Bryan , Texas , USA;6. Associate Professor, Department of Health Services Research, Management and Policy , University of Florida , Gainesville , Florida , USA;7. Professor, Department of Health Services Administration , University of Alabama at Birmingham , Birmingham , Alabama , USA |
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| Abstract: | Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents—the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments. |
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| Keywords: | direct care staffing incentive payments Medicaid nursing homes provider behavior quality |
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